Pharmacist On Board No Cure for Home Rx Errors

by David Pittman David Pittman,Contributing Writer, MedPage Today
July 03, 2012

Action Points

Clinically important medication errors are common after hospital discharge, with adverse drug events occurring in 11% to 17% of patients during the first few weeks post discharge.

Note that in this study, important medication errors were frequently present following discharge in patients hospitalized with heart conditions and were not significantly reduced by a pharmacist-delivered intervention.

Providing hospitalized patients with individualized instruction from pharmacists, including a follow-up phone call post discharge, failed to reduce the number of medication errors after leaving the hospital, a study found.

About half of 851 study patients had a medication error during the first month after hospital discharge, regardless of whether they received usual attention or some special assistance to reduce errors, Sunil Kripalani, MD, MSc, of the Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues reported.

"These results highlight the difficulty of improving medication safety during the transition from hospital to home," they wrote in the July 2 issue of the Annals of Internal Medicine.

Clinically important medication errors are common after hospital discharge, with adverse drug events occurring in 11% to 17% of patients during the first few weeks, the investigators noted. Pharmacists and clinicians have long searched for ways to cut down on preventable post-discharge medication errors and adverse drug reactions.

To look at one possible solution, the researchers conducted a randomized, controlled trial of patients hospitalized in separate academic medical centers in Nashville and Boston for heart conditions. The mean age of the patients was 60 years, and 41.4% were women.

Intervention patients received instruction on correct medication use before leaving the hospital and were given education and health literacy aids upon discharge. Pharmacists took special precautions to ensure accurate prescriptions and gave patients a phone call 1 to 4 days after discharge to help answer any medication-related questions. The control group received usual care, which did not include telephone follow-up.

Still, the average number of clinically important medication errors was similar in the intervention group as with the standard-care group (0.87 versus 0.95 errors per patient, respectively; 95% CI 0.77 to 1.10). The difference was not statistically significant. Among the clinically important errors experienced by patients, nearly 23% were thought to be serious and 1.8% were thought to be life-threatening.

Patients in the intervention group had a lower rate of potential errors (28.6% versus 30.8%), defined as medication discrepancies or non-adherence during the first 30 days after discharge.

The negative results shouldn't be generalized for all settings, however, the researchers noted. The two hospitals in the study, Vanderbilt University Hospital in Nashville and Brigham and Women's Hospital in Boston, had medication reconciliation services for all patients before the study, making it difficult to show an effect from the study's intervention.

Further, the study participants were generally well educated (14 years of education on average) and had a low prevalence of poor health literacy (10%). The intervention, "which was designed to accommodate the needs of patients with low health literacy or cognitive impairment, may be more effective among those populations," the study authors wrote.

Other limitations noted by the investigators included the fact that the patients were limited to those with cardiovascular conditions, so the results might differ in other populations; and that not all participants received the entire intervention.

Kripalani and colleagues called for further work in this area as hospitals face increasing penalties for rehospitalization rates. Not all pharmacist interventions are effective ways to cut down on medication errors, the group said. Different interventions than the types they studied, such as home visits, clinic-based support and closer post-discharge surveillance, may be needed to reduce medication errors.

The study was funded by the National Heart, Lung, and Blood Institute, the Department of Veterans Affairs, and the National Center for Research Resources.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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